World Neurosurg
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The presence of residual tumor is crucial in decision-making for low-grade gliomas (LGGs), because patients older than 40 years of age with residual tumor are considered for adjuvant treatment. There are hints that early postoperative fluid-attenuated inversion recovery (FLAIR) and T2 (within 48 hours) may overestimate residual tumor volume in LGG. Intraoperative magnetic resonance imaging (MRI) without subsequent resection or ultra-early postoperative MRI may assess the amount of residual tumor more adequately. To evaluate the utility of postoperative imaging in LGG, we volumetrically analyzed intraoperative, early, and late (3-4 months after surgery) postoperative MRIs of LGGs. ⋯ Intraoperative MRI without further resection or ultra-early postoperative MRI seems to reflect the actual volume of residual tumor in LGG more precisely compared with early postoperative MRI and therefore seems to be more useful regarding decisions for adjuvant therapy.
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Comparative Study
Biomechanical Study of Three Atlantoaxial Proactive Vertebral Artery Injury Prevention Fixation Combinations.
To evaluate the biomechanical stability of 3 atlantoaxial proactive vertebral artery injury prevention fixation combinations. ⋯ The combination of C1LH and C2ILS supplemented with contralateral TAS or C1LH and TAS or C1LH and C2ILS was superior to bilateral TAS fixation with regard to biomechanics and vertebral artery safety.
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Clinical Trial
A new subcutaneously anchored device for securing external CSF catheters: Our preliminary experience.
Accidental dislocation or removal is a well-known complication of external cerebrospinal fluid (CSF) drainage in daily clinical practice. At present, no data about the incidence of such complications are available in the scientific literature. SecurAcath (Interrad Medical, Plymouth, Minnesota, USA) is a subcutaneously anchored device recently adopted for securement of central venous catheters, known to be highly effective (and cost-effective) in reducing the risk of catheter dislodgement and/or accidental removal. ⋯ In our experience, SecurAcath is a safe and effective device to secure CSF external catheters to the skin, with several relevant advantages: its placement and maintenance are easy; it may stay in place for the entire duration of the catheter; it allows a more complete antisepsis of the exit site, thus reducing local skin complications; it eliminates the risk of suture-related needlestick injuries.
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Mild traumatic brain injury (mTBI), defined as blunt trauma to the head resulting in witnessed loss of consciousness, definite amnesia, or witnessed disorientation with a Glasgow Coma Scale (GCS) score of 14 or 15 is a common occurrence in the emergency department. In mTBI, oral anticoagulation is known to be an important risk factor for hemorrhage. Clinical guidelines recommend baseline computed tomographic (CT) scan and observation for 24 hours plus a CT scan before discharge. ⋯ Patients with a GCS score of 15 who are taking long-term anticoagulation therapy and who present with mTBI have a risk of cranial hemorrhage that is likely to be similar to that of non-anticoagulated patients. It may be reasonable to envision a protocol including only one CT scan and an appropriate observation period.
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Meningioma is a hypervascular tumor of the central nervous system. Angiographic disappearance of tumor blush after preoperative feeder embolization allows qualitative, but not quantitative, assessment of flow reduction. Pseudocontinuous arterial spin labeling (PCASL), which has evolved from magnetic resonance imaging techniques, allows noninvasive measurement of cerebral blood flow (CBF) using water protons in the arterial blood flow. ⋯ PCASL could yield quantitative assessment of blood flow in meningioma including flow reduction rate in cases of feeder embolization.